A sign inside the reSTART clinic asks that cellphones be turned off. Creating structure is key to patients' recovery once they leave the facility.

Caitlin Dickerson
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Originally published on October 22, 2013 4:49 pm

A facility outside Seattle, surrounded by pine trees, is a refuge for addicts — of technology.

There are chickens, a garden and a big treehouse with a zip line. A few guys kick a soccer ball around between therapy appointments in the cottage's grassy backyard.

The reSTART center was set up in 2009. It treats all sorts of technology addictions, but most of the young men who come through here — and they are all young men — have the biggest problem with video games.

There are beds for seven patients at a time. After they spend six intensive weeks of rehab here, they go to a transitional situation — an apartment close by, where they live with other former reSTART patients.

That step used to be called Level 2, but program manager Rachell Montag says that was too similar to video game language, so they changed it.

"In gaming, the goal is always to be moving forward and leveling up, and so we didn't want our language to parallel that, because it can actually have an effect on their behavior and their recovery process in that phase," she tells NPR's Rachel Martin.

'Good, Clean Fun,' At First

Joey M'Poko's story is like a lot of people who come through this place. His personal life was unstable and he moved around a lot. About six months ago, he came to the U.S., where his grandparents live. He was lonely, shy, insecure, and he found a kind of escape in front of his computer.

M'Poko says he would spend hours at a time gaming or watching movies. He says he had bad hygiene and lost weight — but he was a part of a virtual community.

"I mean, I have people I would consider to be friends there, only because I spent most of my time with them. I got to know them," he says.

The kicker here is that M'Poko thought he was doing pretty well, because a couple of years before, he was smoking a lot of pot. He started getting heavily into gaming as an alternative to getting high.

"It was just an environment to meet new people who had no interest in drugs or whatever — they're just looking for good, clean fun, I guess," he says.

M'Poko says he understands how using video games to escape can be damaging. But in his case, he says it made him "feel like socializing again."

"I started to feel like a person again. I could totally zone out all the pain, all whatever, and just go into this total world of fantasy, and it was awesome," he says. "I didn't have to care about anything else."

A 'Flood' Of Addiction

Hilarie Cash, who founded the rehab program, has been studying Internet and technology addiction since the 1990s. She noticed a pattern early on in her patients about how the Internet was affecting their lives.

"And [I] had this sense back then that I was seeing the trickle before the flood. And the flood is upon us," she says.

But in today's increasingly digital world, it can be difficult to sense the point at which extensive Internet use actually becomes an addiction.

A common thread between all addictions, Cash says, is that addicts use the chemical or behavior to find either a high or relief. The behavior becomes an addiction when you are "doing it to such an extent that it begins to control you rather than you being able to control it," she says.

Are you getting enough exercise, sleep and quality time with the people you care about? "If [the behavior] is interfering, then there's a problem there somewhere," Cash says.

Typically, she says, those who come to her facility for help have been gaming from a young age, and the addiction has "been growing over many years." Also, they've been engaging in activity online rather than developing personal relationships.

Often, families will push their sons to limit their activity while they're living at home and going to high school. But once college hits, Cash says, that structure is lost. "And so that's when everything starts falling apart."

Rebuilding A Life

Building patients back up happens in a lot of ways. Some are very basic, like teaching them how to cook healthful meals. M'Poko is in the kitchen with a couple of the other patients, making Italian chicken and pasta for dinner with help from the house manager.

A big guy dressed in workout clothes walks in, with a bald head and a quick smile. There are high fives and friendly slaps on the back.

Isaac Veisburg was born in Venezuela and raised between there and Miami. He's all done with the reSTART program and is now working as a personal trainer. But it was a long road. He went through the six-week, inpatient part of the program twice.

"The first time, I was very guarded. I didn't want to hear the word 'addict.' As far as I was concerned, I could stop whenever I wanted," he says.

He bailed on the program after a few weeks and went back to college in Washington, D.C. At first he tried to stay away from gaming, but he was depressed, fighting with his parents and had car problems.

The stress started to mount, and the Saturday before classes even began, Veisburg was back in front of the computer. He says he downloaded a game and didn't leave his computer for 42 hours.

"And then I slept. I slept through my first class Monday, and I didn't go to class the rest of that day, and the day after, or for five weeks after that," he says.

His parents sent him back to the reSTART program, and eventually he finished the whole thing. Veisburg is now living in Redmond, Wash., hoping to eventually become a counselor for other people working through technology addiction.

He says he doesn't miss gaming — "not even a little bit" — or the people he used to interact with online.

"How well can you really know someone over the Internet? ... Out here is real relationships," he says, "the relationships I have with the guys in [reSTART], you know, with my girlfriend, with my parents, now that we can actually talk. Those are relationships."

Veisburg appears to be on the right track now, but not everyone's path is so clear.

The Need For A Plan

Nov. 5 is the anniversary of Will's arrival to the reSTART program. Will, who asked NPR not to use his last name, has had a series of relapses. At one point, he left the program and lived in a homeless shelter for a month.

After a year in rehab, he's finally done and planning to move back home to Oklahoma to try to find a job. But that's tough to do without using a computer and an Internet connection.

"It's a constant struggle," he says. "It's just that I have to structure my life to a point where I don't feel tempted to waste time on it."

He says he has to hold himself accountable, by having a job, a social life and exercising — and by setting time limits on his Internet usage. He's not planning to get a smartphone anytime soon, either.

Cash, the head therapist and founder of reSTART, says those kinds of boundaries are crucial to any kind of addiction recovery. "All addictions, they say, it takes about two years for the brain to really heal itself," she says.

Before they leave, patients have to form a "life balance plan." They outline their goals and the possible pitfalls ahead.

"Once they leave here, they actually starting implementing that," Cash says. "What's hardest is implementing it successfully. But if they can do that for six months or more, then we're looking at somebody who has a really good shot at living a good, healthy life."

One Step At A Time

Finding that healthy balance also means learning to relax in new ways, which is why reSTART includes weekly meditation sessions. M'Poko is sitting with the rest of the patients in a semicircle in the living room. The instructor is in the middle, leading the meditation.

M'Poko is done with the inpatient program in a just a couple days. He's not sticking around for the second, transitional phase. He wants to move on now. He may move to Japan to teach English.

His family life is still shaky. His dad is moving back to his native Congo, his mom is in Vermont, and M'Poko doesn't know where home is anymore.

"Anyone who's been in a 12-step program or any kind of recovery program will tell you that the addiction is just a symptom of something else," he says. "I feel like I'm slowly cultivating skills that would help me deal with that and make me see that I don't have to escape, and it's much healthier and it feels much better to just ride the storm."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

(SOUNDBITE OF MUSIC)

RACHEL MARTIN, HOST:

This is WEEKEND EDITION from NPR News. I'm Rachel Martin. And this morning, we're talking about how addiction touches the lives of so many Americans.

UNIDENTIFIED MAN #1: I just couldn't really understand what was going on, why I was so depressed, why I was so pissed off at everything.

MARTIN: Mm-hmm.

UNIDENTIFIED MAN #2: I was in sort of a state of complete denial. I had dropped out of college after about a year and a half, couldn't really keep myself motivated enough to do it and kind of realized I had a problem.

JOEY M'POKO: I, like, could totally zone-out all the pain or whatever and just go into this total world of fantasy. And it was awesome, I didn't have to care about anything else.

MARTIN: These are the kinds of things you often hear from addicts in recovery. But these guys aren't in rehab for drugs or alcohol. They're at a facility outside Seattle Washington, to try to kick their addiction to technology.

RACHELL MONTAG: This is backyard area. We have chickens, which we can go over there...

MARTIN: The program is called reSTART and it was set up in 2009 in a renovated cottage surrounded by pine trees.

MONTAG: The clients are actually responsible for taking care of them, cleaning the cage, so it's kind of practicing responsibility for another...

MARTIN: The program manager Rachell Montag is showing us around the property. She tells us there are beds for seven patients at a time. Besides the garden, there's a big treehouse with a zip-line and a huge grassy backyard where a few guys kick a soccer ball around between therapy appointments.

(SOUNDBITE OF SOCCER BALL BEING KICKED)

MARTIN: The center treats all sorts of technology addictions, but most of the young men who come through here - and they are all young men - have the biggest problem with video games. After the patients spend six intensive weeks of rehab, they go to a transitional situation, an apartment close by where they live with other former reSTART patients. That used to be called Level 2, but Montag says that was too similar to video game language so they changed it.

MONTAG: In gaming, the goal is always to be moving forward and leveling up. And so, we didn't want our language to parallel that because it can actually have an affect on their behavior and their recovery process in that phase.

MARTIN: One of the guys playing soccer is Joey M'Poko.

M'POKO: M'P-O-K-O.

(LAUGHTER)

M'POKO: My dad is from the Congo.

MARTIN: Joey's story is like a lot of people who come through this place. His personal life was unstable. His parents divorced, and he moved around a lot. [POST-BROADCAST CORRECTION: M'Poko's parents are not divorced.] A few years ago, he ended up in Chicago, where his grandparents live. He was shy, lonely, and he found a kind of escape in front of his computer.

M'POKO: When I got Chicago I was really bored.

MARTIN: Yeah.

M'POKO: I didn't have any friends. I didn't know the area. But I had a laptop so I spent a lot of time on that. I would spend 12 hours-plus on it, either gaming or watching movies. I had bad hygiene. I'd lost like 10 to 15 pounds all over the course of, like, three, four months.

MARTIN: What was a game?

M'POKO: It was killed "Age of Wushu." It's like a Ming Dynasty-type game where you create your own style of martial arts.

MARTIN: These are these games where it's you and other people who are different characters in the game, and you're at this virtual community...

M'POKO: Yeah.

MARTIN: ...playing together.

M'POKO: Exactly.

MARTIN: So did you have relationships with those people you were chatting with?

M'POKO: Yeah. It was a little more personal than typing because the people I was being gild with we would speak to. I mean, I have people that I consider to be friends there only because I spent most of my time with them and I got to know them and stuff and...

MARTIN: So your conversation expanded beyond the game.

M'POKO: Yes. Yes. I mean, some of them I would - we became Facebook friends.

MARTIN: The kicker here is that Joey thought he was doing pretty well because a couple years before, he was smoking a lot of pot. He started getting heavy into gaming as an alternative to getting high.

M'POKO: It was just an environment to meet new people who had no interest in drugs or whatever and we're just looking for good, clean fun, I guess. And, you know, I can see how it's usually damaging for a person to hide behind that. But for me it actually kind of...

MARTIN: It felt like a good choice.

M'POKO: Yeah. I mean, well, it actually made me feel like socializing again. I started to feel like a person again. I could totally zone-out all the pain, all whatever and just go into this total world of fantasy. And it was awesome. I didn't have to care about anything else.

DR. HILARIE CASH: Little by little, I was seeing these people coming into my office for therapy work and this was a common theme, is something to do with the Internet, and how out of control it was for them and how much it was affecting their lives.

MARTIN: This is Hilarie Cash. She founded this rehab program and has been studying Internet and technology addition since the 1990s.

CASH: And had the sense back then that I was seem to trickle before the flood. And the flood is upon us. I don't have to tell you, we live in a connected world and we're all online a lot.

MARTIN: I don't have to tell you, we live in a connected world and we're all online a lot. How do you define being addicted to the Internet? How is it different than living a healthy life in a busy technological world?

CASH: All addictions have certain characteristics in common, whether they're behavioral or chemical. And it has to do with engaging with the chemical or the behavior, to find either a high or relief, and doing it to such an extent that it begins to control you rather than you being able to control it. But if you can be really honest with yourself and say, OK, do I get enough exercise? Do I get enough sleep? Do I spend time face-to-face with people that I love and care about? You're good to go. But if it is interfering, then there's a problem there somewhere.

MARTIN: So what is an unhealthy addiction look like? What changes someone from being a 19-year-old who likes Internet gaming to someone who finds himself tucked into your facility?

CASH: Typically, these are guys who very often have been gaming since they were quite young. And so, this is an addiction that has been growing over many years. And they've been caught up, let's say, in video games and porn and general surfing and looking at anime and watching movies online. And they've been doing that rather than developing relationships face to face, rather than learning how to flirt and court and date, and rather than getting they are responsibilities met.

And so often families who are trying to cope with this situation - even if they're letting their kids play a lot of video games and spend time alone - at least they're kind of on their case about getting through high school. And so the kid graduates and maybe goes off to college. But in college there's no longer that parental structure. So now there's nobody stopping them from just doing what they actually want to be doing, which is online all the time. And so that's when everything starts falling apart.

(SOUNDBITE OF WATER AND COOKING UTENSILS)

MARTIN: Building them back up happens in a lot of ways, some very basic, like teaching them how to cook healthy meals.

M'POKO: Hey, so I really suck at cutting tomatoes.

MONTAG: So cut in half, cut in half, cut in half, cut in half.

MARTIN: Joey M'Poko is in the kitchen with a couple of the other patients making Italian chicken and pasta for dinner with help from the house manager.

MONTAG: Smaller, like dicing slices. Just...

M'POKO: Wait, you said. OK. Like this half? Should I cut like that?

MONTAG: Yeah.

MARTIN: In walks a big guy dressed in workout clothes - bald head, quick smile - there are high fives and friendly slaps on the back.

(LAUGHTER)

M'POKO: Isaac?

ISAAC VEISBURG: How you been?

M'POKO: You look good, dude. You been working out?

VEISBURG: Yeah.

M'POKO: Losing weight?

MARTIN: This is Isaac Veisburg. He was born in Venezuela and raised between there and Miami. He's all done with the reSTART program and is now working as a personal trainer. But it was a long road. He went through the six week in-patient part of the program twice.

VEISBURG: The first time, I was very guarded. I didn't want to hear the word addict. As far as I was concerned I could stop whenever I wanted.

MARTIN: He bailed on the program after a few weeks, went back to college in Washington, D.C. At first he tried to stay away from gaming, but he was depressed. He was fighting with his parents. He had car problems. The stress started to mount and before classes even began, Isaac was back in front of the computer.

VEISBURG: Right the Saturday before school was starting, a buddy of mine calls me up and says, hey man, we miss you around in the game. Why don't you come hang out with us? And I was really stressed out so, you know, I said, yeah, you know, I'll do that. So I turned on my computer, downloaded the game and then I didn't leave that computer for 42 hours. And then I slept and I slept through my first class Monday. And I didn't go to class the rest of that day, or the day after or for five weeks after that.

MARTIN: His parents sent him back to the reSTART program and eventually he finished the whole thing. Isaac is now living in Redmond, Washington, hoping to eventually become a counselor for other people working through technology addiction.

Do you miss gaming?

VEISBURG: No. Not even a little bit.

MARTIN: Really? Those people, those relationships?

VEISBURG: They weren't relationships. You know, how well can you really know someone over the Internet? Eighty-some percent of human communication is nonverbal. Out here, there's real relationships, the relationships I have with the guys in there, you know, with my girlfriend, with my parents now that we can actually talk. Those are relationships.

MARTIN: Isaac appears to be on the right track now but not everyone's path is so clear.

WILL: November 5th will be end of the first year of me getting here...

(LAUGHTER)

WILL: ...which I'm not really proud of. But it just takes this long. I mean for me...

MARTIN: This is Will. He doesn't want us to use his last name. Will has had a series of relapses that have kept him here at reSTART for an entire year. At one point, he left the program and lived in a homeless shelter for a month. After a year in rehab, he's finally done and planning to move back home to Oklahoma to try to find a job. But that's tough to do without using a computer and an Internet connection.

WILL: It's a constant struggle and you're not going to be able to really avoid using the Internet or anything like that. It's just that I have to structure my life to a point where I don't feel tempted to waste time on this.

MARTIN: So, when you leave reSTART and go back into the world and move back to Oklahoma, how do you use the Internet in a healthy way?

WILL: Even if I had to set my own restrictions, like, it's holding yourself accountable as well, because you're not always going to have someone who's going to watch over you, and you really don't want someone to watch over you at all times. My big thing is keeping myself on a consistent, structured basis, i.e. having a job, having a social life, eating healthy, exercising on a daily basis. And it's also if I need to use the Internet, giving myself a certain amount of time, and once that time limit hits, I'll say, OK, I need to get off.

MARTIN: You feel like you can do that?

WILL: Yeah. It's hard. It really is hard. Like, how much people use, like, cell phones nowadays. I don't think I'll probably get a smartphone for the next maybe two years.

MARTIN: Hilarie Cash, the head therapist and founder of reSTART says those kinds of boundaries are key to any kind of addiction recovery.

CASH: All addictions, they say, it takes about two years for the brain to really heal itself. And before they leave here, we ask them to design what we call a life balance plan. So, what are their goals? What are going to be the pitfalls along the way? When do they plan to have a computer again? When do they plan to have a smartphone again? When they do, how are they going to use it? What are going to be the boundaries they're going to set around it? And so once they leave here, they start implementing that. And actually what's hardest is implementing it successfully. But if they can do that for six months or more, then we're looking at somebody who has a really good shot at living a good, healthy life.

MARTIN: And that means learning to relax in new ways.

UNIDENTIFIED MAN #3: So, today, why don't we look at our thoughts, recognize a thought as it's occurring and then releasing the thought...

MARTIN: Which is why reSTART includes weekly meditation sessions.

UNIDENTIFIED MAN #3: Can we check in with you, Joey?

MARTIN: Joey M'Poko is sitting with the rest of the reSTART patients in a semicircle in the living room. The instructor is in the middle leading the meditation.

UNIDENTIFIED MAN #3: And when these thoughts come in...

MARTIN: Joey's done with the inpatient program in just a couple of days. He's not sticking around for the second part of the program when you're supposed to transition to regular life. He wants to move on - now. He may move to Japan to teach English. His family life is still shaky. His dad is moving back to the Congo. His mom is in Vermont. And Joey doesn't know where home is anymore.

But he knows it is not inside of a video game.

M'POKO: Anyone who's been in a 12-step program or any kind of recovery program will tell you that the addiction is just the symptom of something else. And I feel like I'm slowly cultivating skills that will help me deal with that and make me see that I don't have to escape and it's much healthier and it feels much better to just ride the storm, I guess.

(SOUNDBITE OF MUSIC)

MARTIN: Therapists and health care professionals across the United States use the Diagnostic and Statistical Manual of Master Disorders - or DSM, as it's known - to diagnose and treat patients. In May, a new disorder was added to the DSM's list of conditions that warrant more research - Internet gaming. Experts say the designation means this online activity is more likely to be recognized as a distinct form of addiction. You can see photos from the reSTART clinic and read more about the program on our website, npr.org, and share how addiction has touched your life by tweeting with the hashtag NPRAddiction.